<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Receive_bank_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-receive_bank_name" data-rule="required" class="form-control" name="row[receive_bank_name]" type="text" value="{$row.receive_bank_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Receive_uname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-receive_uname" data-rule="required" class="form-control" name="row[receive_uname]" type="text" value="{$row.receive_uname|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Receive_bank_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-receive_bank_no" data-rule="required" class="form-control" name="row[receive_bank_no]" type="text" value="{$row.receive_bank_no|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Receive_bank_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-receive_bank_number" data-rule="required" class="form-control" name="row[receive_bank_number]" type="text" value="{$row.receive_bank_number|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
